JPH0866405A - Ligature setting method for ligator and ligature setting tool - Google Patents

Abstract

PURPOSE: To simplify work of setting a ligature to a ligator and to make possible quick ligature operation with a ligature in such a state that a knot is previously made. CONSTITUTION: A tubular member 50 is equipped on the tip part of a ligator and a ligature 34 is tied on the periphery of the tubular member 50 by a knot 53 for ligation. By shifting the knot 53 toward the axis direction to a designated position of the ligator after the tubular member 50 is outwardly set on the tip of the ligator, a ligature 34 is set on the position.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suture attaching method and a attaching jig for attaching a suture with a predetermined knot to a ligating device suitable for ligation, particularly in endoscopic surgery. is there.

[0002]

2. Description of the Related Art In recent years, endoscopic surgery has attracted attention in place of conventional open surgery. In this operation, for example, as shown in FIG. 14, a tubular trocar 90 is pierced through the abdominal wall and gas is injected into the abdomen 92 so that the abdomen 9
2 is inflated, the forceps (pin) 94 and the laparoscope (a kind of endoscope) 9 are passed through the abdomen 92 through the trocar 90.
The operation is performed while inserting 6 or the like (in the illustrated example, the gallbladder 98 near the liver 97 is excised). This operation does not require cutting of blood vessels, nerves, muscles, etc., unlike the conventional laparotomy, and therefore has the advantage that the operation trace is not conspicuous and early recovery is possible.

[0003] Conventionally, when suturing and ligating in this endoscopic surgery, a suture operation is performed while holding a needle with a needle holder in the abdomen, and a knot for ligation is made outside the abdomen. ing. However, in order to proceed with this work, many complicated procedures such as changing the needle and taking the suture out of the trocar have to be performed, and such work can be performed with an endoscope that does not provide a stereoscopic view. It's never been easier to do.

In view of this, Japanese Patent Laid-Open No. 6-54855 proposes a ligating device in which a needle holding piece can be retracted from the tip of a cylindrical cartridge. According to this device, ligation can be easily performed according to the following procedure.

A knot for ligating (for example, a leaf knot) around the cartridge immediately above the holding piece in advance.
The sutures are tied in with and the sutures behind the knot are inserted into the push tube.

The holding piece and the cartridge are inserted into the abdomen, and the needle is sutured.

After suturing, the suture portion in the vicinity of the needle is grasped again by the holding piece, and the tip of the thread and the needle are pulled into the cartridge body together with the holding piece.

The knot is pushed forward from the cartridge by a push tube and transferred to the suture site.
By pulling the thread end in this state, the knot can be ligated.

[0009]

In the above device, a nurse or the like must attach a suture around the cartridge with a predetermined knot before ligating. Therefore, if the ligation work is repeated many times with the same ligation device,
It is necessary to repeat the above mounting work.

However, the work of attaching the suture thread to the cartridge while forming the knot and the operation of inserting the suture thread into the push tube are troublesome, and much less work is required while wearing gloves during the operation. With considerable difficulty. This is a major obstacle to shortening the operation time.

In view of such circumstances, it is an object of the present invention to provide a suture thread mounting method and a suture thread mounting jig which can quickly tie a suture thread to a ligating device with a simple operation.

[0012]

SUMMARY OF THE INVENTION The present invention is a suture thread mounting method for tying a suture to a predetermined portion of a ligature device with a predetermined knot, and a tubular member which can be externally fitted to the tip of the ligature device. The suture is tied around the knot with the knot, the tubular member is externally fitted to the tip of the ligating device, and then the knot is axially shifted to be transferred to a predetermined portion of the ligating device ( Claim 1).

Further, the present invention is a suture thread mounting jig for carrying out the above method, which comprises a tubular member which can be externally fitted to the distal end portion of the ligating device, and the suture thread is provided around the tubular member. They are tied with the knot (claim 2).

In this jig, it is more preferable that the distal end portion of the tubular member is provided with a needle holding portion for holding a surgical needle joined to the end portion of the suture thread (claim 3). in this case,
As the needle holder, it is preferable to fill the inside of the distal end of the tubular member with a soft material capable of piercing the surgical needle (claim 4).

Further, by inserting a portion of the suture behind the knot into the push tube for pushing the knot forward from the distal end of the ligating device, a more excellent effect as described later is obtained. Is obtained (Claim 5).

[0016]

According to the jig of the second aspect, as in the first aspect, a tubular member to which a suture is tied in advance with a predetermined knot is externally fitted to the distal end portion of the ligating device, and then the knot is pivoted. The suture can be set in the ligation device while the knot is formed by simply shifting the ligature in the direction and transferring the ligature to a predetermined portion of the ligation device.

In the jig according to the third aspect of the present invention, if the surgical needle connected to the end of the suture is held in the needle holding portion provided at the tip of the tubular member, the jig can be handled. Sometimes the surgical needle does not hang. Specifically, claim 4
In the jig described, the surgical needle can be held only by inserting the surgical needle into the soft material filled inside the distal end portion of the tubular member.

In the jig according to the fifth aspect, the portion of the suture behind the knot is inserted into the push tube. Therefore, if the push tube is directly attached to the ligating device, the device can be used. Can start. Therefore, it is not necessary to insert the suture thread into the push tube immediately before the ligation operation.

[0019]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described with reference to FIGS.

4 to 10 show an example of a ligation apparatus for endoscopic surgery to which the present invention is applied.

The illustrated ligating apparatus 10 comprises an inner cylinder 12, an outer cylinder 14, and an operating portion 20, and inside the inner cylinder 12 there are two movable holding rods 17, 18 and one fixed holding rod 19. And have been inserted. As shown in FIG. 6, the movable holding rods 17, 18
Are arranged on the left and right and face the fixed gripping rods 19, and a file surface 1 for holding the needle is provided on the inner surface of the tip of each of the gripping rods 17 to 19.
6 is formed.

In FIG. 4, 13 is the inner cylinder 12 described above.
It is a collar part for operating in the axial direction.

As shown in FIGS. 7 and 8, the operating section 20 is provided.
Has a tube holding block 22 and two support plates 24 extending rearward from the tube holding block 22, and the rear portions of both support plates 24 are connected by connecting members 25 and 26. An operation plate 30 is attached to the inside of each support plate 24 so as to be swingable around a pin 28.
The left and right wing parts of are connected by a pin 32.

The inner cylinder 12 has the cylinder holding block 22.
Is pierced in the axial direction and is relatively movable in the same direction, and the tail ends of the holding rods 17 to 19 project rearward from the tail end of the inner cylinder 12. The tail end of the fixed holding rod 19
It is fixed to the connecting member 26 in a state of penetrating the connecting member 25 and is immovable relative to the operating portion 20. A closed curve portion 17 is provided at the tail ends of the two movable holding rods 17, 18.
a and 18a are respectively formed, one pin 32 penetrates the closed curve portion 17a, and the other pin 32 penetrates the closed curve portion 18a. Therefore, as the operation plate 30 swings, the left and right movable holding bars 17 and 18 move in opposite directions as shown in FIG.

As shown in FIG. 10 (a), each holding bar 17
The tip end portions of Nos. 19 to 19 originally have a shape that is curved outward in the radial direction in the state where no external force is applied. Then, in this state, the inner cylinder 12 is moved forward relative to the operating portion 20 and the respective holding bars 17 to 19, so that the inner cylinder 12 holds the respective holding bars 17 to 19 as shown in FIG. Is constrained from the outside in the radial direction and is bent inward in the radial direction.

Therefore, in the open state of FIG. 10 (a), the needle 36 at the tip of the suture thread 34 is clamped by the holding pieces 17 as shown in FIG.
19 to 19 and then from this state to the closed state shown in FIG.
It is possible to change the angle of the clamped needle 36 by moving the gripping rods 17 to 18 forward and backward by the swinging operation of the operation plate 20.

The inner cylinder 12 is longer than the outer cylinder 14 and is inserted inside the outer cylinder 14 so as to be relatively movable in the axial direction. The tip end side opening 14a of the outer cylinder 14 has an opening area enlarged by the amount of oblique cutting. A push tube holding tube 40 is formed on the outer peripheral surface of the outer tube 14, and a push tube 38 can be inserted into the push tube holding tube 40. A suture 34 can be inserted into the push tube 38. Has become. A fixed tube 42 is fixed to the outer side of the outer tube 14 and the push tube holding tube 40 in the radial direction so as not to move relative to them, and a flange portion 44 for operation is formed on the outer peripheral surface of the fixed tube 42.

When using the ligation device 10, the outer cylinder 1
It is necessary to tie the suture thread 34 to the peripheral surface of the distal end portion of No. 4 with a predetermined knot. An example of a jig for that purpose is shown in FIG.

This jig is provided with a tubular member 50, and the tubular member 50 has an inner diameter capable of being fitted onto the tip portion of the outer tube 14. Around the tubular member 50, an intermediate portion of the suture thread 34 is tied with a knot 53 necessary for ligation described later, and the suture thread 34 on the rear side of the knot 53 is inserted into the push tube 38. There is. Further, the tip end portion of the tubular member 50 is filled with a needle holding portion 52 made of a soft material such as sponge, absorbent cotton, and non-woven fabric.
When the needle 36 is pierced into the
It is held at the end of 0. The inner diameters at both ends of the tubular member 50 differ depending on the shape of the distal end portion of the outer tube 14, and therefore, the knot 53 is attached to the tubular member 50 during transportation or operation of the jig.
If there is a risk of falling off, a fall prevention ring 55 may be provided near the center of the outer periphery of the tubular member 50.

The knot 53 may be of any type as long as it can be ligated as described later, but a so-called "fishing line knot" is adopted in the illustrated example. The knotting procedure is shown in Figure 2.
And shown in FIG.

First, a loop 54 is formed by intersecting an intermediate portion of the suture thread 34 (FIG. 2 (a)), and the suture thread 34 on the tip side of the loop 54 is wound around the tubular member 50, and then the loop is formed. It is passed through 54 (FIG. 2 (b)). In this way,
The suture thread 34 is wound around the tubular member 50 a predetermined number of times while passing through the loop 54 (FIG. 7C). And FIG. 3 (a)
By pulling the rear end of the suture thread 34 rearward as shown in FIG. 5, the suture thread 34 can be tied to the tubular member 50 as shown in FIG.

By using this jig, as shown in FIG. 11 and FIG.
As shown in (a), the tubular member 50 is externally fitted to the distal end portion of the outer tube 14, the push tube 38 is inserted into the push tube holding tube 40 from the front, and then the knot 53 is displaced with a finger or the like. , The knot 53 is transferred from the peripheral surface of the cylindrical member 50 to the peripheral surface of the outer cylinder 14 (FIG. 12 (b)), and thereafter,
By removing the tubular member 50 from the outer casing 14,
The suture 34 can be tied with the knot 53. Therefore, the suture thread 34 can be attached to the ligation device 10 very easily as compared with the conventional method in which the suture thread 34 is directly tied to the outer tube 14 with the knot 53 each time the ligation is performed, and the time required for the operation can be significantly reduced.

Further, as in this embodiment, if the suture thread 34 is inserted into the push tube 38 in the attaching jig, the push tube 38 is inserted into the push tube holding tube 40 to ligate. It can be started, and the working time can be further shortened as compared with the case where the suture thread 34 is inserted into the push tube 38 each time ligation is performed.

If the needle holding portion 52 is provided at the tip of the tubular member 50 and the needle 36 is held by the needle holding portion 52 as in this embodiment, the needle 36 does not wander in the jig, The jig can be handled more safely. In particular, in the case where a soft material is loaded into the tubular member 50 as the needle holding portion 52, the needle 36 can be securely held with a simple structure and by a simple operation of just sticking the needle 36 into the needle holding portion 52. Will be possible.

The ligation procedure after the suture thread 34 is attached is as follows.

By the axial operation of the inner cylinder 12 with respect to the operation unit 20 and the rotation operation of the operation plate 30, FIG.
As shown in (3), the middle portion of the needle 36 is grasped at a predetermined angle by the three holding rods 17 to 19.

In this state, the entire ligation device 10 is inserted into the abdomen through the trocar 90 shown in FIG.

The needle 36 is hooked on the sutured portion 60 as shown in FIG. 13, and once the holding of the needle 36 is released, the needle 3
6, grasp the tip of the needle 6 again, and attach the needle 36 to the sutured portion 60.
(Ie, thread the suture 34 through the suture site 60).

A portion of the suture thread 34, which is slightly away from the needle 36, is grasped again by the holding rods 17 to 19, and the outer tube 1
4, the inner cylinder 12, the operation unit 20, and the holding rod 17 to
Move 19 back together. As a result, the distal end portions of the needle 36 and the suture thread 34 are retracted from the opening 14a of the outer cylinder 14 and are drawn into the outer cylinder 14 (FIG. 13).
State).

The push tube 38 with respect to the outer cylinder 14
Is advanced to push the knot 53 forward from the tip of the outer cylinder 14 and move it to the sutured portion 60. By pulling the end portion of the suture thread 34 in this state, it is possible to ligate with one needle suture. After the ligation, the suture thread 34 is cut at an appropriate site, and the next ligation work is performed.

In the above embodiment, the case where the suture thread 34 with the needle 36 is handled is shown. In the case of ligating, the knot 53 can be formed on the peripheral surface of the outer cylinder 14 by using the jig and the method in which the suture thread 34 having no needle is tied, so that the ligation can be started quickly. In this case, the needle holding portion 52 is not necessary, and the tip of the suture thread 34 is held by the holding rod 17 to.
The suture 34 is held around the exfoliated portion by using another instrument inserted into the abdomen through the other trocar 90 and held by the tip of 19, and the tip of the suture 34 is grasped again with the holding rods 17 to 19, It may be pulled into the outer cylinder 14 and ligated by the same method as described above. Also, the push tube 38
Can also be omitted, and in this case, the knot 53 may be removed from the outer tube 14 forward by another device inserted into the abdomen through another trocar.

[0042]

INDUSTRIAL APPLICABILITY As described above, the present invention is a jig in which a suture thread is tied around a tubular member that can be externally fitted to the distal end portion of a ligating device with a knot for ligating. When the suture is tied directly to the ligature device every time the ligature is attached, since the knot is axially shifted and then transferred to a predetermined portion of the ligation device after being fitted onto the distal end of the device. Compared to, sutures can be attached very easily,
This has the effect of significantly reducing the time required for surgery.

Particularly, in a jig having a needle holding portion at the tip of the tubular member, holding the surgical needle connected to the end of the suture thread may cause the surgical needle to hang up from the jig. This makes it possible to handle the jig more safely. More specifically, in the case where the distal end of the tubular member is filled with a soft material, there is an effect that the needle can be securely held with a simple structure and a simple operation of just inserting the surgical needle into the soft material. .

Further, in a jig in which the portion of the suture behind the knot is pushed through a push tube for pushing the knot forward from the tip of the ligating device, the push tube is used as it is. The ligation work can be started just by mounting it on the device. Therefore,
As compared with the case where a suture thread is inserted into the push tube each time the ligation is performed, the time required for the operation can be further shortened.

[Brief description of drawings]

FIG. 1 is a perspective view of a suture thread mounting jig according to an embodiment of the present invention.

2 (a) to (c) are perspective views showing a procedure of tying a suture thread to a tubular member in the mounting jig.

3 (a) and 3 (b) are perspective views showing a procedure of tying a suture thread to a tubular member in the mounting jig.

FIG. 4 is a side view of a ligation device using the suture thread mounting jig.

FIG. 5 is a plan view of the ligation device.

FIG. 6 is a front view of a distal end portion of the ligation device.

FIG. 7 is a cross-sectional rear view of an operation portion of the ligation device.

FIG. 8 is a cross-sectional plan view of the operation unit.

FIG. 9 is a plan view of a distal end portion of the ligation device.

FIG. 10 (a) is a side view showing a state in which a holding bar is opened at a tip portion of the ligation device, and FIG. 10 (b) is a side view showing a state in which the holding bar is closed.

FIG. 11 is a perspective view showing a state before the attachment jig is attached to the ligation device.

FIG. 12 (a) is a perspective view showing a state in which the tubular member of the mounting jig is externally fitted to the outer tube of the ligating device, and FIG.
FIG. 3 is a perspective view showing a state in which the knot of the suture is transferred from the tubular member to the outer tube in the state of FIG. It is a perspective view shown.

FIG. 13 is a perspective view showing a use state of the ligation device in the abdomen.

FIG. 14 is a cross-sectional view showing an outline of endoscopic surgery.

[Explanation of symbols]

 10 Ligation Device 34 Suture Thread 36 Needle 38 Push Tube 50 Cylindrical Member 52 Needle Holder 53 Knot

Claims (5)

[Claims] 1. A suture thread attaching method for tying a suture thread to a predetermined portion of a ligature apparatus with a predetermined knot, wherein the suture thread is provided around a tubular member that can be externally fitted to a distal end portion of the ligature apparatus. A suture is attached to the ligation device, which is characterized in that the tubular member is tied with a knot, the tubular member is externally fitted to the distal end portion of the ligation device, and then the knot is axially displaced to be transferred to a predetermined portion of the ligation device. Method. 2. A suture thread mounting jig for tying a suture thread to a predetermined portion of a ligature device with a predetermined knot, comprising a tubular member which can be externally fitted to a tip end portion of the ligature apparatus. A suture thread mounting jig for a ligation device, characterized in that the suture thread is tied around the knot. 3. The suture thread mounting jig for a ligation device according to claim 2, wherein a needle holding portion for holding a surgical needle coupled to an end portion of the suture thread is provided at a distal end portion of the tubular member. A jig for attaching a suture thread to a ligation device, which is characterized in that: 4. The suture thread attachment jig for a ligation device according to claim 3, wherein a soft material capable of piercing the surgical needle is filled inside the distal end portion of the tubular member as the needle holding portion. A suture thread attachment jig for a ligation device. 5. The suture thread attachment jig for a ligature device according to claim 2, wherein a portion of the suture behind the knot is forwarded from the tip of the ligature device. A suture thread attachment jig for a ligation device, which is inserted through a push tube for pushing out the knot.